Clinical decision support for intervention reduction in neonatal patients: A usability assessment

Objective This study investigated how effectively simplified cognitive walkthroughs, performed independently by four nonclinical researchers, can be used to assess the usability of clinical decision support software. It also helped illuminate the types of usability issues in clinical decision support software tools that cognitive walkthroughs can identify. Method A human factors professor and three research assistants each conducted an independent cognitive walkthrough of a web-based demonstration version of T3, a physiologic monitoring system featuring a new clinical decision support software tool called MAnagement Application (MAP). They accessed the demo on personal computers in their homes and used it to walk through several pre-specified tasks, answering three standard questions at each step. Then they met to review and prioritize the findings. Results Evaluators acknowledged several positive features including concise, helpful tooltips and an informative column in the patient overview which allows users direct (one-click) access to protocol eligibility and compliance criteria. Recommendations to improve usability include: modify the language to clarify what user actions are possible; visually indicate when eligibility flags are snoozed; and specify which protocol\u27s data is currently being shown. Conclusion Independent, simplified cognitive walkthroughs can help ensure that clinical decision support software tools will appropriately support clinicians. Four researchers used this technique to quickly, inexpensively, and effectively assess T3\u27s new MAP tool, which suggests positive actions, such as removing a patient from a ventilator. Results indicate that, while there is room for usability improvements, the MAP tool may help reduce clinician\u27s cognitive load, facilitating improved care. The study also confirmed that cognitive walkthroughs identify issues that make clinical decision support software hard to learn or remember to use

Direct Support Professionals\u27 Perspectives on Using Technology to Help Support Adults With Autism Spectrum Disorder: Mixed Methods Study.

BACKGROUND: Documentation is a critical responsibility for direct support professionals (DSPs) who work with adults with autism spectrum disorder (ASD); however, it contributes significantly to their workload. Targeted efforts must be made to mitigate the burden of necessary data collection and documentation, which contributes to high DSP turnover rates and poor job satisfaction. OBJECTIVE: This mixed methods study aimed to explore how technology could assist DSPs who work with adults with ASD and prioritize aspects of technology that would be most useful for future development efforts. METHODS: In the first study, 15 DSPs who worked with adults with ASD participated in 1 of the 3 online focus groups. The topics included daily tasks, factors that would influence the adoption of technology, and how DSPs would like to interact with technologies to provide information about their clients. Responses were thematically analyzed across focus groups and ranked by salience. In the second study, 153 DSPs across the United States rated the usefulness of technology features and data entry methods and provided qualitative responses on their concerns regarding the use of technology for data collection and documentation. Quantitative responses were ranked based on their usefulness across participants, and rank-order correlations were calculated between different work settings and age groups. The qualitative responses were thematically analyzed. RESULTS: In study 1, participants described difficulties with paper-and-pencil data collection, noted benefits and concerns about using technology instead, identified benefits and concerns about particular technology features, and specified work-environment factors that impact data collection. In study 2, participants rated multiple features of technology as useful, with the highest usefulness percentages endorsed for task views (ie, by shift, client, and DSP), logging completed tasks, and setting reminders for specific tasks. Participants also rated most data entry methods (eg, typing on a phone or tablet, typing on a keyboard, and choosing from options on a touch screen) as useful. Rank-order correlations indicated that the usefulness of technology features and data entry methods differed across work settings and age groups. Across both studies, DSPs cited some concerns with technology, such as confidentiality, reliability and accuracy, complexity and efficiency, and data loss from technology failure. CONCLUSIONS: Understanding the challenges faced by DSPs who work with adults with ASD, and their thoughts about using technology to meet those challenges, represents an essential first step toward developing technology solutions that can increase DSPs\u27 effectiveness and job satisfaction. The survey results indicate that technology innovations should incorporate multiple features to account for different needs across DSPs, settings, and age groups. Future research should explore barriers to adopting data collection and documentation tools and elicit input from agency directors, families, and others interested in reviewing data about adults with ASD

How do novel seat positions impact usability of child restraints?

Autonomous driving technology and changes in regulations may create an environment that allows novel vehicle interiors. It is important to consider impact on all types of passengers when contemplating interior design, particularly for vehicles that may be used by families with children. We developed a fixture that enables us to change the orientation of each of 4 car seats and used it to simulate three different vehicle interiors. Ten families with children aged 3 months to 7 years interacted with each of the simulated interiors as part of a usability study. Times to install and remove child restraint systems were not significantly different across the three simulated vehicle interiors, but parents were able to release children fastest when using the “X” configuration, which had all seats on a diagonal facing the middle of the vehicle. While overall experience ratings didn’t differ significantly, seven out of ten parents indicated that they liked the “X” configuration better than the other two configurations tested. Reasons included: ability to interact with other passengers, ability to see the road, and legroom/comfort. However, many participants disliked having some passengers not facing forward. Overall, parents liked facing their children, but several said that they would only be comfortable if they could see out of the front windshield; meanwhile, children liked seeing their parents’ faces but also preferred to face forward. Child restraint system and vehicle manufacturers could benefit from considering this study when designing new products

Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation.

BACKGROUND: Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE: This study aimed to (1) identify the information about elderly patients\u27 recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety. METHODS: A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. RESULTS: The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 helpful, but not always necessary items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. CONCLUSIONS: Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization